ABSTRACT
ABSTRACT Objective: This study aims to evaluate the impact of morning-evening preference in pregnancy outcomes in gestational diabetes mellitus (GDM). Materials and methods: This is a prospective cohort study of 2nd-3rd trimester GDM outpatient care in Fortaleza, Brazil (2018-2020). Eveningness was defined by the Horne-Östberg Morningness-Eveningness-Questionnaire (MEQ ≤ 41). Furthermore, we obtained a 7-day actigraphic register. Subjective sleep quality, daytime somnolence, insomnia, fatigue and depressive symptoms were also evaluated. Associations with pregnancy outcomes were investigated. Results: Among 305 patients with GDM, evening preference was found in 21 (6.9%). Patients with evening preference had worse sleep quality (p < 0.01), greater severity of insomnia (p < 0.005), fatigue (p < 0.005) and depressive symptoms (<0.009). Evening chronotype was associated with preeclampsia [p = 0.01; OR = 0.27; CI 0.09-0.79] and a greater need for admission to a neonatal intensive care unit (NICU) [p = 0.02; OR = 0.23; CI .0.06-0.80]. A lower MEQ score confirmed an association with preeclampsia [p = 0.002; OR = 0.94; CI 0.90-0.97] and this was maintained after controlling for age, arterial hypertension, sleep quality, fatigue and depressive symptoms [p < 005; OR = 0.91; CI 0.87-0.95]. Conclusion: In GDM, patients with evening preference had worse sleep quality, more insomnia, fatigue, and depressive symptoms. Furthermore, eveningness was independently associated with preeclampsia. These results indicate the important role of eveningness in adverse pregnancy outcomes.
ABSTRACT
Introdução: estudo proposto por alunos do Programa de Educação pelo Trabalho em Saúde (PET-SAÚDE) da Universidade Federal de Minas Gerais (UFMG), linha de cuidados em saúde do adolescente. A adolescência caracteriza-se por profundas modificações que marcam a passagem da infância para a vida adulta. A gravidez nesse período os expõe a situações de vulnerabilidade, capaz de limitar projetos futuros. Objetivo: avaliar aspectos biopsicossociais associados à gravidez na adolescência. Métodos: pesquisa qualitativa com 23 adolescentes da área de abrangência de um Centro de Saúde de Belo Horizonte que tiveram seus partos entre janeiro/2009 e junho/2011. Convidadas a responder um questionário estruturado abordando escolaridade, trabalho, vida social, saúde e renda familiar, 14 aceitaram participar e assinaram o TCLE. Resultados: a idade média do parto foi de 17 anos. Nove tiveram menarca precoce e quatro tiveram início de atividade sexual precoce; sete usavam método contraceptivo quando engravidaram; 13 realizaram pré-natal; sete tiveram parto operatório; e dois tiveram neonato de baixo peso. Houve ampla adesão à amamentação. Três abandonaram os estudos para cuidar do filho e apenas uma estava trabalhando. Todas se consideravam responsáveis pelo cuidado com o filho, porém 11 necessitavam de apoio financeiro. Contudo, a maternidade foi percebida de forma positiva pela maioria, pois oito relataram mais satisfação com a vida após o parto. Conclusão: há contradição entre os dados e a percepção positiva da jovem em relação à sua vida. Isso alerta para a importância de expor situações reais a essas jovens, para que a gravidez seja uma escolha consciente...
Introduction: This is a study proposed by students within the Education Program for Health Work Force at the Federal University of Minas Gerais (UFMG), particularly within the domain of health care for adolescents. Adolescence is a period of deep changes that characterize the transition from childhood to adulthood. Pregnancy in this period exposes adolescents to a myriad of vulnerability situations that may frustrate their projects for the future. Objective: To assess the bio-psychosocial features associated with adolescent pregnancy. Methods: This is a qualitative study of 23 adolescents living within the reaches of a Public Health Center in the City of Belo Horizonte that had their babies from January 2009 through June 2011. They were invited to fill out a structured questionnaire approaching their education level, jobs, social life, health and family income, but only 14 of them accepted to participate and provide their informed consent. Results: The participants were in average 17 years old. Nine of them had early menarche, and four of them initiated their sexual activity very early; seven adolescents were using a contraceptive method when they got pregnant; 13 had prenatal care; seven had operative delivery; and two delivered underweight newborns. Most of them breastfed their infants. Only one was working, and three of them left school to take care of their children. All of them deemed themselves as responsible for taking care of the child, but eleven claimed to need financial support. Most of them had a positive conception of maternity, i.e. eight adolescents reported to feel more satisfied with their lives after than before having a baby. Conclusion: The data of the adolescents seems to be inconsistent with their positive perception of their lives. This is a warning of the importance of exposing the adolescents to real life situations that allow them to get pregnant as a result of a reflected choice...